Association between Colonoscopy Rates and Colorectal Cancer Mortality

Linda Rabeneck MD; MPH; Lawrence F Paszat MD; MS; Refik Saskin MSc; Therese A Stukel PhD


Am J Gastroenterol. 2010;105(7):1627-1632. 

In This Article

Abstract and Introduction


Objectives: Although colonoscopy use has increased in the United States and Canada since the early 1990s, it is unclear whether this has been associated with benefit at the population level. Our objective was to evaluate the association between regional colonoscopy rates and death from colorectal cancer (CRC).
Methods: We conducted a natural experiment involving a 14-year follow-up of a cohort of all men and women 50–90 years of age living in Ontario on 1 January 1993 exposed to different intensities of colonoscopy use. Each member of the study cohort was assigned to a region each year, on the basis of his/her residence. Each individual was followed up through 31 December 2006; age- and sex-standardized CRC incidence rates were calculated and all CRC deaths were identified. Each year, for each region, the rate of colonoscopies performed on persons 50–90 years of age, per 1,000 population 50–90 years of age, living in the region, was calculated. Multivariable cox proportional hazards models were used to evaluate the association between colonoscopy rate and death from CRC, adjusting for age, sex, comorbidity, income, and location of residence (urban/rural).
Results: The study cohort comprised 2,412,077 persons 50–90 years of age. The mean age was 64 years, and 53.7% were women. Colonoscopy rates increased in all regions during 1993–2006. The increased rate of complete colonoscopy was inversely associated with death from CRC. For every 1% increase in complete colonoscopy rate, the hazard of death decreased by 3%.
Conclusions: Increased colonoscopy use was associated with mortality reduction from CRC at the population level.


Colorectal cancer (CRC), the second leading cause of cancer-related deaths in the United States and Canada, accounts for 10% of all cancer deaths.[1,2] Colonoscopy is endorsed as an option for CRC screening by the US Multi-Society Task Force on Colorectal Cancer,[3] the US Preventive Services Task Force,[4] and the Canadian Association of Gastroenterology.[5] Colonoscopy is the gold standard for detecting and removing adenomas, and colonoscopic polypectomy is associated with a reduction in CRC incidence.[6] In the United States and Canada, colonoscopy use has risen rapidly since the early 1990s.[7,8,9,10] However, it is unclear whether the increased use of colonoscopy has been associated with clinical benefits at the population level.

Our primary objective was to evaluate the association between colonoscopy use and death from CRC in a population-based study.


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